Research: ceasarean sections and epidurals are safe

#MSBlog: pregnancy in MS; caesarian section and epidural anaesthesia are safe regarding the course of your disease; but not post-partum relapses.

Epub: Pastò et al. Epidural analgesia and cesarean delivery in multiple sclerosis post-partum relapses: the Italian cohort study. BMC Neurol. 2012;12:165.

BACKGROUND: Few studies have systematically addressed the role of epidural analgesia and caesarean delivery in predicting the post-partum disease activity in women MSers. 

OBJECTIVE: The objective of this study was to assess the impact of epidural analgesia and caesarean delivery on the risk of post-partum relapses and disability in women MSers.

METHODS: In the context of an Italian prospective study on the safety of immunomodulators in pregnancy, we included pregnancies occurred between 2002 and 2008 in women MSers regularly followed-up in 21 Italian MS centers. Data were gathered through a standardized, semi-structured interview, dealing with pregnancy outcomes, breastfeeding, type of delivery (vaginal or caesarean) and epidural analgesia  The risk of post-partum relapses and disability progression (1 point on the Expanded Disability Status Sclae, EDSS, point, confirmed after six months) was assessed through a logistic multivariate regression analysis.

RESULTS: We collected data on 423 pregnancies in 415 women. Among these, 349 pregnancies resulted in full term deliveries, with a post-partum follow-up of at least one year (mean follow-up period 5.5+/-3.1 years). 155 MSers (44.4%) underwent caesarean delivery  and 65 (18.5%) epidural analgesia. In the multivariate analysis neither caesarean delivery  nor epidural analgesia ere associated with a higher risk of post-partum relapses. Post-partum relapses were related to a higher EDSS score at conception (OR=1.42; 95%CI 1.11-1.82; p=0.005), a higher number of relapses in the year before pregnancy (OR=1.62; 95%CI 1.15-2.29; p=0.006) and during pregnancy (OR=3.07; 95% CI 1.40-6.72; p=0.005). Likewise, caesarean delivery and epidural analgesia are not associated with disability progression on the EDSS after delivery. The only significant predictor of disability progression was the occurrence of relapses in the year after delivery (disability progression in the year after delivery: OR= 4.00; 95%CI 2.0-8.2; p<0.001; disability progression over the whole follow-up period: OR= 2.0; 95%CI 1.2-3.3; p=0.005).

CONCLUSIONS: These findings, show no correlation between epidural analgesiacaesarean delivery and postpartum relapses and disability. Therefore these procedures can safely be applied in MSers. On the other hand, post-partum relapses are significantly associated with increased disability, which calls for the need of preventive therapies after delivery. 

“Good news for woman MSers; caesarian sections and epidural anaesthesia has no impact on MS.”

“Not surprising post-partum relapses were associated with disability progression; as most of these woman were either on or going back onto DMTs it confirms numerous other studies that have demonstrated that relapses  on DMTs are bad news. This is contrary to natural history data, i.e. not on DMTs, that show that relapses are a poor predictor of disability progression. Why the disconnect between natural history and DMT related relapses is interesting and is telling us something fundamental about this disease. I suspect that if you are having relapses on DMTs the DMT is clearly not affecting that component of the disease that is driving relapses. What that is one of the grand challenges in MS.”

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About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.


  • This begs the question: Should women with MS choose to have children? What are the implications both for the health of the MSer and the emotional wellbeing of her child?

    To willingly have children after a diagnosis of MS seems questionable. It's no different from images of starving people in Africa having multiple births even though their children will suffer in unprecedented ways.

    We're lucky enough to have higher levels of education and understanding, therefore why do we push to have children when the odds are stacked against us?

    • Some of the research posted above answer your question about the implications for the health of the woman: pregnancy does not appear to influence your MS fate.

      Why do we push to have children? It's the only way to get them out
      (bada boom)

  • Er, that's supposing that all MS is the same. It isn't.
    After 13 years, I'm still fit and walking. I've been on beta-interferon for 12 of these years and after it started working, I've had 3 relapses.
    I had my kids before diagnosis, but would still have had MS brewing away in my brain.
    Okay, that's just me, but I have plenty of friends with kids who are still well.
    What next? The health police are going to have anyone with a diagnosis sterilised for their own good and the emotional wellbeing of their children?
    Daft. We do what we can. If we have kids, we treasure them and give them the best we can. Okay, so mum can't walk 3 miles, but then neither can a 5 year old.
    Oh dear, the comments on here can be so frustrating, ignorant and plain insulting and quite often extraordinarily illogical.

    • Actually all MS is principally the same, it just affects the sufferer in different ways and at varying timelines. All MSers are headed in the same direction and have the exact pathology at play. It's all brain damage. It's neurology. It's all biology.

  • These professionals just copy n paste links most of the time they havent a clue about MS and never will and have never given birth either

By Prof G



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